ArticleBJA open2026
Development and internal validation of models to predict postoperative troponin and myocardial injury after noncardiac surgery by incorporating hypotension as a predictor: single-centre retrospective cohort study.
Article in BJA open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05188001 (Development and Internal Validation of Models Involving Vital Signs to Predict Troponin Level and Myocardial Injury After Non-cardiac Surgery), which is not on this map. Not yet cited in PubMed.
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Development and Internal Validation of Models Involving Vital Signs to Predict Troponin Level and Myocardial Injury After Non-cardiac Surgery: a Single-centre Retrospective Cohort Study
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11 authors.
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Abstract
Background: Myocardial injury after noncardiac surgery (MINS) is associated with poor outcomes. Current prediction models have limitations and rarely incorporate postoperative hypotension. Our primary objective was to develop and validate a prediction model incorporating postoperative hypotension to predict subsequent postoperative high-sensitivity cardiac troponin T concentrations and MINS. Methods: We conducted a single-centre retrospective cohort study of patients aged ≥45 yr who underwent inpatient noncardiac surgery between 2020 and 2021 at St. Paul's Hospital, Canada. We excluded patients with missing vital signs or postoperative troponin concentrations, those who underwent repeat surgery <72 h after surgery, and those who were readmitted <72h after surgery. We developed multivariable linear mixed-effects models using percentage of time with postoperative hypotension (mean arterial pressure <75 mm Hg) on postoperative days (PODs) 0-2, age, sex, emergency surgery, and revised cardiac risk index to predict maximum troponin concentration on PODs 1-3 (primary model) and MINS (secondary model). Internal validation was performed using repeated patient-based five-fold cross-validation with 100 repetitions, using the root mean square error (RMSE), marginal R-squared (R Results: We included 846 patients (mean age 72 yr [standard deviation 11]; 57.4% male). Notably, 35% of patients (299 of 846) developed MINS between PODs 0 and 3. The primary linear mixed-effects model for log-transformed troponin showed a conditional R Conclusions: A model including postoperative hypotension to predict postoperative troponin concentrations fits our data well, but did not show sufficient accuracy and is not ready for clinical practice. Better-quality data and additional clinical variables may enhance model development.Trial registration. Clinicaltrials.gov NCT05188001, registered 7 January 2022.
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